Scenario
J.S. is an 8-year-old male who is short in stature. His parents have become concerned as J.S. has been wetting his bed, drinking a lot of water, and appears sluggish. The doctor orders several blood tests after J.S.’s urine test was positive for glucose and ketones.
Diseases That Should Be Ruled Out in This Patient
According to the symptoms that the patient is experiencing, it is possible to rule out diseases such as:
- Dehydration
- Anemia
- Diabetes mellitus.
The first and most apparent reason that indicates that the patient is drinking excessively is dehydration. Severe thirst and dry mouth on the background of unfilled fluid loss (with diarrhea or vomiting, profuse sweating) signal urgent restoration of water balance in the body. However, the patient has other symptoms that exclude the possibility of this disease. Anemia is a pathological condition characterized by a decrease in red blood cells and hemoglobin (the threshold level of iron-containing protein (hemoglobin) in the blood is less than 120 g/l) (Du et al., 2018). It occurs with nonspecific symptoms – it is impossible to say with certainty based on the manifestation that it is anemia. However, the patient will have low hemoglobin, which excludes the disease.
Diabetes mellitus is a disease characterized by the inability of the kidneys to reabsorb water and concentrate urine. It has, at its core, a defect in the secretion or action of vasopressin and is manifested by marked thirst and the excretion of large amounts of diluted urine (Hill-Briggs et al., 2021). It is determined by a fall rather than a rise in blood sugar levels, which contradicts the conditions of the case. Therefore, this type of diabetes is not characteristic of the patient who sought help.
Symptoms of Diabetes
Symptoms of diabetes develop depending on the stage of the process. The disease can evolve gradually or become an acute condition – a coma. To organize the signs of diabetes, they are divided into two categories: primary and additional. Firstly, it is necessary to focus on the study of the primary symptoms, the first of which is polyuria, which is frequent urination, increasing the volume of fluid excreted. It occurs since high levels of glucose increase osmotic pressure, which affects the work of the renal tubules. Moreover, diabetes can be the reason for such symptoms as:
- Polydipsia. With diabetes, an intense thirst is not associated with physical exertion or weather conditions. If in the usual mode of life, the patient notes a fierce appetite and frequent desire to drink water (Gupta et al., 2020). Such a clinical sign is associated with increased fluid loss.
- Polyphagia. A person is constantly hungry, and hunger and thirst are not connected with the surrounding conditions or increased loads. The reason is that more nutrients are spent, and their metabolism in the tissues is disturbed (Gupta et al., 2020). Glucose is in the blood but does not get into the cells. It affects the receptors; the body perceives the situation as a lack of glucose and increases the appetite to replenish the supply.
- Weight loss. As glucose metabolism is disrupted, the catabolism of fats and proteins increases. It leads to a decrease in body volume and weight. Losing weight occurs with increased appetite, which further increases it.
Considering all the symptoms is significant because only a comprehensive approach can provide effective treatment. Thirst is the first indicator that may signify the possibility of diabetes in this case. Moreover, the patient is only eight years old, and age must be evaluated when determining the most suitable treatment. Medical intervention should consider the symptoms and possible treatment risks, which can be done through a comprehensive diagnosis.
Diagnostic Methods
There are the following diagnostic methods for glucose metabolism disorders:
- Determination of blood glucose levels;
- Glucose tolerance test;
- Glycated hemoglobin determination;
- Urine tests for acetone and glucose and determination of their levels;
- C-Peptide test.
The blood glucose concentration determination shows how well insulin performs its function, whether the glucose is delivered to the cells or whether it is in the blood. A person’s average blood glucose concentration is 3.3 -5.5 mmol/l (Cole & Florez, 2020). If the result is below the intermediate level, it is called hypoglycemia. It occurs with poisoning, functional disorders of the digestive tract, some liver and pancreatic diseases, diabetes mellitus, chronic liver, pancreatic pathology, hyperkalemia, and cerebral hemorrhage. The technique is indicated for the pathology of the liver, pancreas, and obesity to confirm or exclude diabetes and monitor its treatment.
The tolerance test is indicated when the blood glucose concentration is within critical limits. The test is performed in the morning, before meals, and no sooner than 8 hours after the last meal. The patient must be calm, without physical exertion or stress. Glycated hemoglobin is an indicator that can distinguish short-term hyperglycemia from the long-term course of pathological glucose metabolism (Alzahrani et al., 2019). The study’s principle is based on detecting and measuring the amount of hemoglobin bound to glucose molecules irreversibly. The technique allows an evaluation of the last three months since that is how long an erythrocyte with altered hemoglobin remains in the blood (Alzahrani et al., 2019). Furthermore, the analysis shows how well the disease has been treated in the past and whether a correction is needed.
Urine examination in diabetes includes analysis of acetone and glucose levels. Assessment of the daily amount of urine is used to determine the total glucosuria in a day. Sometimes the study is divided into time intervals so that four portions of urine are obtained. A single urine sample is the standard procedure for deciding on glucosuria or excluding it. The C-peptide test is part of the diagnosis of diabetes because it is a product of carbohydrate metabolism and shows its quality in the body. As a rule, the level of this substance corresponds to the concentration of insulin in the blood (Alzahrani et al., 2019). A decrease in C-peptide accompanies insulin resistance and pancreatic islet pathology. Elevated concentration indicates the presence of type 2 diabetes, and reactions to glucose-lowering drugs may reveal the presence of insulinoma, insulin antibodies, neuroendocrine processes, and kidney problems.
The assignment of one research method depends on the stage of the process and the doctor’s recommendations. Combining different tests is desirable for the diagnosis to be complete and cover various aspects of carbohydrate metabolism. Quality diagnosis of diabetes allows starting treatment in time, which corresponds to the body’s condition. If blood glucose levels are stabilized and adhere to typical concentrations, several complications can be avoided.
Treatment and Prognosis
The choice of treatment methods for diabetes mellitus depends on the type of disease, but any form of the disease requires compulsory diet, exercise, and physical activity. Drug therapy is the treatment with insulin, from traditional subcutaneous injections at regular intervals to continuous subcutaneous administration of insulin into the patient’s body with the help of a medical device, an insulin pump. For the treatment of type 2 diabetes, antidiabetics-sugar-lowering drugs are used either orally or in combination with insulin therapy (traditional or with an insulin pump) (Abdoli, 2020). With optimal treatment and the correct regulation of blood sugar levels, the prognosis for diabetes and life expectancy is relatively favorable.
At the same time, the course of diabetes can be complicated by the development of specific body disorders. These include diabetic retinopathy, diabetic nephropathy, polyneuropathy, and atherosclerosis. Moreover, people with diabetes have several times the risk of heart stroke, myocardial infarction, and heart failure. If considering type 1 diabetes, preventive measures in the traditional sense are hardly practical since this type of diabetes is an autoimmune disease (Abdoli, 2020). Physical activity and a suitably chosen diet for type 2 diabetes are therapeutic and of great preventive value.
References
Abdoli, S., Hessler, D., Smither, B., Miller-Bains, K., Burr, E. M., & Stuckey, H. L. (2020). New insights into diabetes burnout and its distinction from diabetes distress and depressive symptoms: a qualitative study. Diabetes Research and Clinical Practice, 169, 108446. Web.
Alzahrani, A., Alghamdi, A., Alqarni, T., Alshareef, R., & Alzahrani, A. (2019). Prevalence and predictors of depression, anxiety, and stress symptoms among patients with type II diabetes attending primary healthcare centers in the western region of Saudi Arabia: A cross-sectional study. International journal of mental health systems, 13(1), 1-7. Web.
Cole, J. B., & Florez, J. C. (2020). Genetics of diabetes mellitus and diabetes complications. Nature reviews nephrology, 16(7), 377-390. Web.
Du, Y. T., Rayner, C. K., Jones, K. L., Talley, N. J., & Horowitz, M. (2018). Gastrointestinal symptoms in diabetes: Prevalence, assessment, pathogenesis, and management. Diabetes care, 41(3), 627-637.
Gupta, R., Ghosh, A., Singh, A. K., & Misra, A. (2020). Clinical considerations for patients with diabetes in times of COVID-19 epidemic. Diabetes & metabolic syndrome, 14(3), 211.
Hill-Briggs, F., Adler, N. E., Berkowitz, S. A., Chin, M. H., Gary-Webb, T. L., Navas-Acien, A., & Haire-Joshu, D. (2021). Social determinants of health and diabetes: A scientific review. Diabetes care, 44(1), 258-279. Web.